1. NECK MASSES

2. Midline Thyroglossal cyst Dermoid cyst Lateral Branchial cyst
Congenital
Midline
Thyroglossal cyst
Dermoid cyst
Lateral
Branchial cyst
Acquired
Inflammatory
Neoplastic
Traumatic (hematoma)

3. Approach History PP: (Age, Sex) Child: congenital or inflammatory
Middle: tumor or inflammatory.
Old: tumor
HPI:
Duration
Painful/painless
Associated Sx (sore throat, URI symptoms)
Systemic Rreview
General (fever, weight loss, malaise…)
Symptoms of hypo/hyperthyroidism
Difficulty swallowing or speaking (esophageal ca)
Respiratory Sx
GI Sx

4. Medication & radiation .
Past medical history
HIV or TB.
Ill-fitting dental appliances.
Chronic oral candidiasis.
Medication & radiation .
Social History : smoking , alcohol , contact with T.B.
Travel History

5. Physical Examination 2. Palpation : 1. Inspection : 3. Percussion :
a. site
b. shape .
c. color .
d. relation to swallowing.
e. relation to tongue protrusion
2. Palpation :
a. temperature .
b. tenderness .
c. size .
d. surface .
e. edge .
f. consistency .
g. fluctuation .
h. pulsatility .
i. relation to skin .
j. mobility .
k. relation to underlying structures .
3. Percussion :
for retrosternal extension of the thyroid
4. Auscultation
for bruits

6. Complete Head & Neck Examination
Look for any mass or ulcer
L.N.
Ear , nose & throat examination
Sinuses
Mouth examination
Thyroid
Pharynx, larynx
Liver, spleen
LNs of body (axilla, inguinal)
Systemic examination RS GI

7. Radiological X-ray: (not helpful).
Barium swallow: in hypopharyngeal diverticulum.
US: differentiate btw solid & cystic masses.
CT: assessment of the mass itself.
MRI: nature of the mass.

8. Labs
TB.
Sarcoidosis.
Hematological (lymphoma, leukemia).

9. FNA
FNA is the golden standard of diagnosis for neck masses If you suspect malignancy.
90% of cases it gives true Dx.
Could have false –ve or false +ve.
Differentiate btw inflammatory & neoplastic masses.

10. NECK ABCESS
In acute bacterial infection there may be suppuration in the nodes of the neck to form a painful abscess.
Treatment is that of the primary condition e.g. acute tonsillitis, infectious mononucleosis.

11. THYROGLOSSAL CYST
Fibrous cyst that forms from a persistent thyroglossal duct.
Most common congenital neck mass
Childhood
Midline mass: between the isthmus of thyroid and the hyoid bone or just above the hyoid bone.
Elevated with tongue protrusion
Painless (if infected  painful)
Smooth and cystic
Presentations:
Dysphagia.
Breathing difficulty.
Dyspepsia especially if large mass.
Rx:
Sistrunk procedure: Total excision with excision of the central part of hyoid bone to avoid recurrence.

12. BRANCHIAL CYST Remnants of embryonic development
Result from failure of obliteration of the branchial cleft
Cystic mass
Develops under the skin between SCM & pharynx.
Presentation:
Asymptomatic (mostly)
Painful if become infected.
Rx:
Surgical excision
Complete surgical excision may be difficult, so they can recur.

14. DERMOID CYST Cystic teratoma
Contains mature skin complete with hair follicles and sweat gland. sometimes clumps of hair, and often pockets of sebum, blood, fat, bone, nail, cartilage and thyroid tissue .
Almost always benign and rarely malignant.
The rare malignant dermoid cyst usually develops  SCC in adults; in infants and children it usually develops an endodermal sinus tumor.
Midline mass that does not move with protruding the tongue.
Solid or hard in consistency.
Usually limited to the skin.
Rx:
Complete surgical removal.

15. INFLAMMTORY LUMPS Acute Inflammation: URTI Ears Tonsils
Cat scratch disease (Bartonella henselae).
Tularemia “Rabbit Fever”(Francisella tularensis).
Chronic Inflammation:
TB (Tuberculous cervical lymphadenitis)
Sarcoidosis
Syphilis
Brucillosis

16. NEOPLASTIC NECK MASSES
Benign or malignant
Primary (above clavicle):
Lymphomas (most common)
Squamous cell carcinoma of branchial cyst.
Melanoma
Rabdomyosarcoma
Present late and the only presentation could be lymphadenopathy.
Secondary: below clavicle (Virchow's node)
Breast (98%), lung, liver, stomach, prostate.
Above clavicle  advanced stage of tumor.

17. PRIMARY-BENIGN Any structure may be involved.
Skin, SC Tissue, fat, nerve, muscle, vessel.
Lipoma, fibroma, haemangioma, neuroma.
Salivary Glands: Pleomorphic adenoma, Wharthin’s tumor.
Thyroid: Multinodular goiter, cyst, adenoma.

18. PRIMARY-MALIGNANT Salivary Glands. Thyroid Gland.
Lymph Nodes: Lymphoma.
Sarcoma.

19. CAROTID BODY TUMOR(PARAGANGLIOMA)
rare neuroendocrine neoplasm originates from paraganglia in chromaffin-negative glomus cell derived from the embryonic neural crest functioning as part of the sympathetic nervous system (chemoreceptors). 
Located at the adventitia of the common carotid artery bifurcation.
It usually presents as a painless neck mass, but larger tumors may cause cranial nerve palsies, usually of the VAGUS NERVE and HYPOGLOSSAL NERVE.
 Rarely, a malignant neuroblastoma may originate from the carotid body.